INDIA Information Sheet

Credentialing Verification Authorities: The prerequisite to Life Membership to the Indian Dietetic Association is a qualified and trained professional in the field of Food Nutrition and Dietetics from a recognised University of India. The Association Accredits the training of Registered Dietitian through a National Registered Dietitian Board which has a standardised competency package of training in RD Board recognised hospitals for a duration of 6 months and the eligibility to appear for National RD Board Examination. Registered Dietitian title certifies your Quality Mark of training for a clinical setting of a hospital in India. However, it's not mandatory in India to be registered/licensed for practicing especially in fields like sports nutrition or food industry, but efforts are on to streamline the same at the National Level.

Official Language(s): English & Hindi

Ongoing Nutrition Activities in India

1. National Dietetic Association Indian Dietetic Association NUTRITION SOCIETY OF INDIA Indian Dietetic Association (HQ) National Institute of Nutrition Campus Silver lake terrace, Richmond road, Indian Council of Medical Research Bangalore – 560025 Jamai Osmania (P.O), near Tarnaka http://idaindia.com/ X-road, Hyderabad - 500 007 Telangana State India Phone : 91- 40 - 27197247, 27197322 Fax: 91-40-27019074 Email : [email protected]

2. National Nutrition Programmes/Projects National Nutrition Mission Integrated Child Development Services Scheme (ICDS) implements several programs to address the problem of malnutrition in India. POSHAN Abhiyaan (National Nutrition Mission) is a flagship programme of the Ministry of Women and Child Development (MWCD), Government of India, which ensures convergence with various programmes i.e., Anganwadi Services, Pradhan Mantri Matru Vandana Yojana (PMMVY), Scheme for Adolescent Girls (SAG) of MWCD Janani Suraksha Yojana (JSY), National Health Mission (NHM), Swachh-Bharat Mission, Public Distribution System (PDS), Department Food & Public Distribution, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) and Ministry of Drinking Water & Sanitation.

3. Organizations working on Health & Nutrition a. National Organizations (Government) Integrated Child FMCH India – Foundation Society for Nutrition, Development Services for Mother & Child Health Education & Health Scheme Action (SNEHA)- Maharashtra b. International Organisations UNICEF 73 Lodi Estate, New Delhi 110 003, India Tel: 91 11 2469-0401, 2469-1410 Fax: 011 2462-7521, 2469-1410 Email: [email protected] c. Educational Institutes (Nutrition Education & Research) National Institute of nutrition. Nutrition society of India Mumbai University SNDT university IGNOU, Distance Education State University Lady Irwin, New Delhi Gujarat University d. Non-Governmental Organizations (NGO's) Innovative Change Collaborative Nutrition Foundation Of India (ICCO) The Indian Nutrition Initiative – TATA Trust 4. Assessment of Training Quality of National Dietitians, their Professional Role and Prestige

Dietitians are mostly required to visit patients, ascertain likes and dislikes, etc. similar to what Diet Technicians might do in the West. Depending on the practice, they may be asked to counsel patients on their diet. Some also plan enteral feeds, using commercial products or kitchen-prepared feeds. Some of the nutrition work such as diet counseling and nutrition support planning may be done by physicians directly.

Dietetics is a low profile and poorly paid career and many opt out of it. Those who do rise to the top of the department, improve their competency and display professionalism finally win the trust and regard of the hospital. Thus in senior positions, there are good dietitians upholding the profession, trying to raise the profile of the dietitians, training the juniors, etc. At lower levels, the dietitians do not have the confidence of the physicians and are mostly only asked to do what they can to optimize the intake. The regard in which the dietitians are held also varies from hospital to hospital.

However, there is a good and much better change in Roles of Nutritionist/ Dietician in India from before & importance is understood by many people but not all. Along with that there is also rise in the number of Nutrition quacks practicing without qualifications.

5. Brief Description of National Healthcare System and Private Practice

There is a dual system of private and Government-provided health care: The Government has primary health centers at the village level, big hospitals at every district HQ towns and in the state capitals. The treatment and medicines (generic) are free. They are reasonably well-equipped. It is possible to find dedicated doctors and good treatment in these hospitals, but they are also open to abuse, poor hygiene and callousness.

Private hospitals again are of many kinds – from small poorly equipped ‘nursing homes’ to modern state-of-the-art facilities second to none in the world. There are also many independent clinics (consulting rooms) of doctors who are affiliated to various hospitals.

‘Mission’ hospitals have a service philosophy – having been originally started by British Missionaries – and provide service at a reasonable cost. They also have ways of subsidizing treatment or giving free services to the needy. There is a level to fit every pocket!

People choose their physicians on the basis of their reputations and connections with family or friends. There is no necessity to go to a GP first, and one is free to consult any specialist directly. 6. Employment Opportunities Profile

The pay is very minimal, unless one can lobby for a high-profile job, such as in a multinational company. Regular jobs such as ones in the Government are impossible to break into – unless one has entered at a young age by writing the Public Service Commission Examination. Teaching jobs too are very competitive. Private hospitals or companies who recognize the value of the RD qualification and have the freedom to create a suitable post are the ones to approach. Again, the remuneration is low in the normal course.

In hospitals of repute, where internationally-trained physicians who recognize the importance of nutrition are at work, one may expect a welcome. The challenge is to get the acceptance of the local dietitians who are used to a different philosophy and approach! The other challenges are the languages and the food knowledge.

There are many clinical and epidemiological research programs carried out by many governmental and non-governmental organizations. It would be quite possible to approach one as a volunteer.

There is rise in number of private practicing dietician from before as there is increase awareness among people around regarding foods nutrition.

7. Obtaining Work Permits

There are two ways for foreign nationals to obtain a work visa in India: 1. A business visa is available if ones’ company has a contract with an organization in India. 2. A work permit is available if one has secured employment with an organization in India. In this case the organization has to apply for the visa.

If one is in India accompanying their spouse there will usually be a condition that one is not allowed to take up employment.

8. Local Food Customs and Culture

India is a very diverse country, divided into states along language lines. There are some fourteen official languages and many dialects. Each state has its own culture, something like what you may find if you take Europe as a whole. In addition, the influence of colonial rule by the British persists, such as English being the working language in most places.

There are different food specialties belonging to every geographic area, religion and caste. While the majority of the population sticks to its own cuisine, the younger and more affluent enjoy trying many other cuisines, so that now some dishes, such as tandoori chicken and dosas are universally known, at least in the cities.

The diet is cereal based, the center-of-the-plate dish being rice or Indian bread. Rice is more popular among the southern states and Bengal (in the East) and breads to the north. Vegetables and meats are side dishes only or made into a curry to be consumed along with the rice or bread.

There is a vast population of vegetarians. Even those who do eat meat do so on some days of the week or once a week only. The amount of meat consumed is also limited to perhaps 2oz (cooked) in most cases. However, the amount of vegetables consumed is also not too much, being about 2-3oz of one or two cooked vegetables. Not everyone eats salad, and if they do, it is limited to about a cup at the most. Some of the accompaniments used – such as pickles (vegetables / meat with a very spicy sauce in oil), chutneys (variety of freshly ground or cooked spicy pastes), papads and vadakams (crisps, fried or roasted), etc. – can add a lot of salt or oil to the diet. So overall, the cereal dish is the major item and it is eaten with something spicy. Fruits, though a great variety is available seasonally, are expensive and not eaten much by the poorer segments of the population. Even those who can afford it do not make it a regular habit to eat fruit.

With increased vegan promotion round the world, very small number of Indians are switching themselves to vegan and Paleo diet. But mostly milk and dairy products are avidly consumed by all.

The three main religions in India are Hinduism, Islam and Christianity, with a small percentage of Zorastrians, Buddhists, Jains, Sikhs, etc. Each has its own basic food habits, such as Hindus do not eat beef and Muslims do not eat pork. Jains have restrictions even regarding vegetables, in that they do not consume onions and garlic and some do not eat any root vegetables. Even among Christians, many will not eat beef or pork. All do not relish items such as bacon and ham. There are traditional dishes originating from each community.

In addition, there is a caste hierarchy. Though castes are not strictly adhered to in the social sense (except in the case of most arranged marriages), some food habits persist. For example, Brahmins will not eat eggs, meat, fish or poultry. But there are always some who cross over to other customs.

The degree of Westernization also determines the type of food eaten by the family. Those who have traveled or lived abroad will eat a variety of foods, the more orthodox in the same community sticking to traditional foods. There are also communities such as Anglo-Indians. Very few really follow a Western type of diet. Fast foods such as pizzas, burgers and fried chicken have entered the market and are becoming popular with the city population, especially the younger generation. The Indian version of Chinese food is extremely popular. Italian, Arabic and Thai food are some of the types of cuisine becoming well-known in the cities.

The disparity between the cities and the countryside is great. Even twenty miles outside the city, there are villages where people live in very traditional ways. Contrary to what one might envisage in the West with regard to villages– free range eggs, fresh produce, etc – in India, villagers are poor and send all the produce to the market in the cities and eat no vegetables or fruit themselves.

There are a great many economic layers and one has to be very sensitive to the economic status of the client when giving diet advice.

9. CE Opportunities

There are no local Academy-recognized or pre-approved continuing education opportunities. However, periodically there are international and national speakers, brought by multinationals such as Ross-Abbott or Nestle. There are also physicians who are members of ASPEN and other international professional bodies who invite speakers from such organizations. There are also local speakers and nutrition-related conferences including annual conferences of the Indian Dietetic Association, ISPEN (Indian version of ASPEN) and diabetic research centers.

CPE opportunities are provided through IAAND professional development activities such as IAAND conferences and webinars, through the Academy distance learning programs, the Journal of the Academy of Nutrition and Dietetics and the Academy Foundation resources.

10. IAAND Volunteer Opportunities

Opportunities to assist IAAND with your time are probably endless. Learn as much as you can about IAAND and where your skills and interest would be of most benefit both to you and to IAAND. You could: ▪ Assist IAAND in spreading awareness about nutrition and dietetics globally and advocating for nutrition issues in your local communities. ▪ Support IAAND’s growth by recruiting new members and assisting fund- raising team. ▪ Be a member on the IAAND leadership team ▪ Assist in organizing conferences ▪ Submit articles to the IAAND newsletter ▪ Be a Kids Eat Right International volunteer.

For further information please contact the Country Rep for India: [email protected]

Written by: Rupal Shah (2019)